spinal shock
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A 17 year-old high school football player presented to a neurology clinic coz his mom thought that he might have acquired neck problems during a game. a month before he had sustained a concussionfrom a blow to his head from another player. shortly after, she noted that he intemittently tilted his head to the side. when asked what was the matter, he simply said that somtimes he had doublevision, and that the images were situated on top of each other vertically, mahing it dificult to go downstairs. when examined, there wasnt neck pain or limitation of movement. he tended to keep his head tilted to the right side. when asked to follow docs finger with his head in straight position, his left eye wouldnot move downword when his eyes were turned to the right, and tended to remain slightly deviated toward the left. at this position, and felt better if his head was tilted to the right the reminder of his eye movements, as well as tthe reminder of his exam, was normal.
1. where has the damage occurrwd?
a. the oculomotor nerve
b. the abducens nerve
c.the trochlear nerve
d. trigeminal nerve
e.facial nerve
2. Which muscle is weakened
a.superior rectus
b.inferior rectus
c.lateral rectus
d. superior oblique
e. inferior obliqur
3. From which portion of the brainstem has the damaged nerve emerged?
a.right ventral midbrain
b.right dorsal midbrain
c.left ventral midbrain
d.left dorsal midbrain
e.left ventral pons
4. whats the action of the weak muscle?
a. outward and upward rotation of the orbit
b.outward and downward rotation of the orbit
c. inward and upward rotation of the orbit
d. inward and downward rotation of the orbit
e. deviation of the orbit laterally
5. how could the head trauma have caused the double vision?
a. direct damage to the eye
b. damage to the occipital lobe
c. damage to the midbrain
d. damage to the pons
e. damage to the cranial nerve peripherally
explain your answer plz
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| new_n_lost
Politically InCorrect
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1. where has the damage occurrwd?
c.the trochlear nerve
2. Which muscle is weakened
d. superior oblique
3. From which portion of the brainstem has the damaged nerve emerged?
b.right dorsal midbrain
4. whats the action of the weak muscle?
d. inward and downward rotation of the orbit
5. how could the head trauma have caused the double vision?
e. damage to the cranial nerve peripherally
The Question in depth is all about Trochlear nerve its actions and its palsy.
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| Tiff
Forum Guru
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Almost agree..
1. Trochlear nerve (CN IV) - Damage to this causes vertical diplopia. Patient has trouble going down stairs. Choice C
2. Superior oblique - is what is controlled by the trochlear nerve. Choice D.
3. Should be midbrain. Cranial nerves 1-4 are midbrain. Cranial nerves 5-8 are pons. Cranial nerves 9-12 are medulla. Trochlear nerves exit from the dorsal midbrain. Since its a left sided problem the damage should be on the right side since it decussates. So, choice B.
4. The action of the superior oblique muscle is to move it down and out. So choice B
5. Head trauma is a cause of peripheral cranial nerve damage, but midbrain damage is also a result of head trauma so I'm torn between but will go with choice E.
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| sidiyaa
Forum Newbie
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It is really a very good Q.
1 is (C ) because the examination roulled out any disease in neck muscles plus the tlting the chin to the right side as a comensatory mechanism.
since there is no musclosketetal problem we should think of cranial nerve damage which tochelar nerve because of the vertical diplopia.
2 D as you know SO4= superior oblique.
3 B : the trochlear decussates within the the midbrain and exit the brain stem on its dorasl surface caudal to the inferior colliculus.
4 B the action of SO is depressing ,intorting, abducting the eye.
5 E because A peripheral lesion is a damage to the bundle of nerves, in contrast to a central lesion, which is a damage to the trochlear nucleus. Acute symtoms are probably a result of a trauma or disease, while chronic symptoms probably are congenital(this paragraph is from wikipedia).
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| Interferon18
Forum Newbie
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(C)CN IV Damaged vertical diplopia,
(D)SO is innervated by CN IV,
(B)midbrain,
(B)inward and down is the action of SO,
(E)
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| macintosh
Forum Elite
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As stated in the question stem the left eye would not move downward when his eyes were turned to the right, and tended to remain slightly deviated toward the left, thereby meaning that this boys left eye is in an upward and outward position. Paralsis of the sup. oblique is therefore implicated. it is supplied by the trochlear nerve, which is the 4th c.n. It therfore arise from the midbrain at the dorsal surface and appears ont eh ventral surface on the opposite side. Even though trauma may result in damage to either midbrain or the nerve bundle, the paucity of any long tract signs point to a damage the the nerve bundle.
Interesting question.
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